RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00313
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Water Treatment Specialist, medically separated for “degenerative arthritis of the spine,” with a disability rating of 10%.

CI CONTENTION:  The CI contends for her unfitting back condition, her not unfitting hypertension, and two conditions not identified by either the MEB or PEB.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:  

IPEB - Dated 20081103	VARD - 20090803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Spine	5242	10%	Lumbar Degenerative Changes	5242	10%	20090531	
Hypertension	Not Unfitting	Hypertension	7101	10%	20090531	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in 2006 with no clear history of injury.  Pain radiating to the lower extremities and associated with numbness and tingling was variably reported.  Magnetic resonance imaging (MRI) studies in January 2007 showed degenerative disc disease of the lumbar spine with no evidence of herniation or nerve root involvement, and electrodiagnostic studies were normal.  There was no surgical indication.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for MEB.  The MEB forwarded “low back pain” for PEB adjudication.
 
The MEB NARSUM examination on 28 September 2008 (3 months prior to separation) recorded complaints of back pain that occurred 4-5 days per week, lasted for hours and intensified with activity.  The physical examination showed tenderness that was described as “non-anatomic.”  After 3 repetitions, thoracolumbar flexion was measured normal at 90 degrees and combined range of motion (ROM) was 230 degrees (normal 240).  The examiner stated “DeLuca's evaluation when applied suggests that she might have a 10-degree change in forward flexion limited by pain.”

At the 31 May 2009 VA Compensation and Pension (C&P) examination, performed 5 months after separation, the CI reported back pain which radiated down both legs but did not affect her ability to walk or to perform activities of daily living.  The radiating pain was associated with lower extremity numbness.  The physical examination showed a normal gait, spinal tenderness, and no spasm.  Thoracolumbar flexion was 70 degrees and combined ROM was 170 degrees.  There was no additional limitation after repetition.  There was some numbness of the right leg, but lower extremity strength was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5242 (degenerative arthritis of the spine), citing painful motion, functional loss and functional impairment.  The VA also rated the back condition 10% coded 5242 (degenerative arthritis of the spine), citing limitation of forward flexion and combined ROM.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) noted on the VA examination and for combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM and the VA C&P examinations.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of incapacitating episodes requiring physician-prescribed bed rest to warrant consideration for rating under the alternate VASRD formula for intervertebral disc syndrome (IVDS).  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI had degenerative disc disease and complained of radiating pain with numbness and tingling.  However, electrodiagnostic studies were negative for neuropathy or radiculopathy, and radiating pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the degenerative arthritis of the spine condition.  

Contended PEB Conditions:  Hypertension.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The hypertension condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the degenerative arthritis of the spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150515, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

07 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002601   (PD201500313)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA